Medicare Secondary Payer: Issues & Answers

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Demystify the Medicare Secondary Program (MSP) with this expert audio conference.

Do you know what the Medicare Secondary Program entails? If you aren’t fully educated about MSP, then you will are likely to feel overwhelmed by how complicated it is. Find out what process you should be using to bill Medicare as a secondary payer. If you’re having problems with Worker’s Compensation claims, there’s a reason.

Expert presenter Duane C. Abbey, PhD, CFP, will show you how to be assured you have all of the correct information, so that you can properly bill MSP. You’ll see how MSP correlates with the Coordination of Benefits Contractor (COBC). You will also outline what to do if you request and receive conditional payment. Learn whether the RACs are interested in MSP problems.

This session will help you:

  • Review the fundamentals of the Medicare Secondary Payer program.
  • Discover how the MSP connects with Group Health Insurance
  • Learn how the MSP is affected by Workers’ Compensation payments.
  • Understand liability insurance coverage in relation to MSP
  • Underline what Medicare does and does not pay as a secondary payer.
  • Work through the calculations to understand what Medicare should pay in different situations.
  • Break down the process of Medicare conditional payment.
  • Check out how the MSP correlates to the COBC (Coordination of Benefits Contractor).
  • Weigh the use of MSP questionnaires and appropriate data gathering.
  • Work through a series of case studies illustrating the complexities of the MSP program.
  • Predict possible audits and recoupments including RAC involvement with MSP.

Teleconference/Webinar Outline/Agenda: 

  • Basics of the Medicare Secondary Payer Program
    • Basic MSP Processes
    • Coverage Issues for MSP
    • Rules, Regulations and Directives
    • Conditional Payment Process
    • Improper Payments
    • Review of CMS Guidance for MSP
  • MSP Relationship to Other Insurance
    • Group Health Plans (GHPs)
      • Determining if GHP Is Primary
      • Spousal Coverage
      • 20 Employee and 30 Employee Limitations
    • Workers’ Compensation Claims
    • Liability Insurance
      • Review of Insurance Coverage
      • Medical Payments (No-Fault)
      • Liability Coverage
    • Working Aged
    • Special Issues
      • End-Stage Renal Disease
      • Multiple Insurers
    • Self-Insured Issues
  • Medicare Payments under MSP
    • Calculating the Amount CMS Pays for MSP Claims
    • Calculating Refunds for MSP
      • Conditional Payments
      • Group Health Coverage Interfaces
      • Deductibles and Coinsurance
    • Interest on MSP Recovery Claims
    • Case Studies
  • Proper Billing and Charging Under MSP
    • Appropriate Charging
    • Proper Claims and Filing Requirements
      • UB-04
      • CMS-1500
  • MSP Questionnaires
    • Review of Suggested CMS Formats
    • Developing Your Own MSP Questionnaires
    • Case Studies
  • Regulatory Issues
    • COBC – Coordination of Benefits Contractor
    • External Audits for MSP Compliance
      • Proper Refunds
      • Proper Identification Through MSP Questionnaires
      • RAC and Recoupment Efforts for MSP
      • Conducting Internal Audits
      • Double Damages Concept
      • Section 111 MSP Mandatory Reporting
  • Sources for Research and Reference.

Who should attend? Compliance Manager, CFO, CEO, COO, Physicians, Patient Financial Services Personnel, Billing Personnel, Claims Transaction Personnel, Compliance Personnel, Utilization Review Personnel, Internal Auditing Staff, Registration Personnel, Clinical Staff, and All Personnel Having Contact with Patients.

Prerequisites for Participating:  General knowledge of hospital and physician billing, Medicare payment systems, and various types of insurance including group health plans, workers’ compensation, and liability coverage.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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